It’s the start of the hurricane season, and Jimmy Walker looks relatively at ease.
This is a bit surprising but also reassuring given that Walker, Senior Vice President for Regulatory & Workforce at SCHA, is responsible for coordinating South Carolina hospitals’ response efforts in an emergency or natural disaster.
When such an event happens, hospitals have to communicate effectively not only with each other but also with federal, state and local emergency preparedness agencies. The result is a tangled web of communication lines whose complexity makes it difficult to get information out efficiently, particularly when time is of the essence. That’s why SCHA serves as a 24-hour operations center during emergencies, coordinating with hospital emergency managers, EMS agencies, government agencies and other critical organizations to provide a central source of information.
This is important because, as Walker points out, “[emergency] preparedness is really a whole lot of stuff.” The intricacies and details of what needs to be done—under what rules and best practices—can easily slide into the weeds.
“There are federal, state and county agencies [involved] in many cases, with all these regulations,” Walker said. “You start talking about what to do during hurricanes—you worry about weather and all of the fallout from that, but you also worry about how you're going to get paid, what to do about your licensures, the impact your actions have with The Joint Commission [a hospital accrediting body], CMS [Centers for Medicare and Medicaid Services]—all of those things get pulled in. It's not just about surviving the storm, it's actually making all of this come together and function.”
In planning for every contingency, the now-distant lessons of Hurricane Hugo and its impact on the Carolinas in 1989 still resonate, but more recent disasters like Hurricane Katrina in 2005 and last year’s historic flooding in South Carolina offer more relevant case studies in how to respond to natural disasters. In recent years, there’s been a pivot away from evacuation-driven plans for hospitals toward a more managed and streamlined approach. The rationale is pretty straightforward and takes into consideration two things: the ways hospitals have changed and the ways hurricanes haven’t.
“We've always said we're going to move everybody out [in the past], but people in our hospitals are too sick to move these days,” Walker explained. “That plan was put into place years ago when you'd go into the hospital and stay for a week to have a baby. Now, you go in and out in 24 hours, or even with complications you’re still probably out in two days. The people who are there really have a high acuity level of problems. You put them in as much risk moving them as you do leaving them there if you've taken all of the right precautions.”
And while hospitals have changed quite a bit, our ability to predict the path of a hurricane has not.
“It’s generally at about only 48 hours out when you really know where a hurricane will hit,” Walker admits. “That’s not enough time to move a hospital. So the typical plan has been that you start evacuating at 96 hours. Think about how long that is—that’s four days, and what if you're wrong?”
Hurricane Floyd provides a good example of this problem. Originally forecasted to hit Florida and then South Carolina, where massive evacuations took place, the storm turned northward and pummeled eastern North Carolina instead.
Now, in lieu of full scale evacuations, hospitals in the projected path of a hurricane start drawing down their patient population by discharging patients who can evacuate on their own and eliminating all elective surgeries. They also begin closing outpatient facilities and affiliated doctor’s offices. SCHA and DHEC work together to help hospitals set an appropriate timeline, anywhere from 48-96 hours out, depending on the severity of the storm.
“Hospitals will try to stay open to the general public for as long as they can,” said Walker.
SCHA also assists hospitals by offering networking and education opportunities. The Association supports the SC Society for Healthcare Emergency Managers, a personal membership group that provides networking, training, education and statewide planning so hospitals are prepared to address emergencies. Members help each other assess potential hazards which they might be vulnerable to and then plan for prevention, response and recovery from threats.
SCHA also hosts a number of different events throughout the year that help facilitate coordinated strategies. Last month, Gov. Nikki Haley held a hurricane tabletop exercise at SCHA with the state’s top emergency management officials to discuss preparations and procedures for evacuation and sheltering both prior to a storm and in its aftermath.
Next Wednesday and Thursday, June 8-9, SCHA will host another event, the Hospital Preparedness Summit & SC Society of Healthcare Emergency Management Meeting, a joint meeting of disaster preparedness professionals from hospitals and state agencies. The two-day program covers everything from hurricanes and floods to mass shootings and terrorist attacks. Emergency medical care professionals with firsthand experience from Hurricane Katrina and the October 2015 flooding will be on one panel, and keynote speaker Carl W. Taylor, JD, is an expert on medical disaster response planning.
For more information on the conference or any of SCHA efforts in disaster preparedness, please email Kim Wooten.